Healthcare Provider Details

I. General information

NPI: 1043426125
Provider Name (Legal Business Name): LANE J LOPEZ DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2859 LOMA VISTA ROAD SUITE A
VENTURA CA
93003
US

IV. Provider business mailing address

2859 LOMA VISTA ROAD SUITE A
VENTURA CA
93003
US

V. Phone/Fax

Practice location:
  • Phone: 805-648-5121
  • Fax: 805-648-3670
Mailing address:
  • Phone: 805-648-5121
  • Fax: 805-648-3670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number18369
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: